Provider Demographics
NPI:1871821298
Name:POP'S CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:POP'S CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-935-1999
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-0190
Mailing Address - Country:US
Mailing Address - Phone:623-935-1999
Mailing Address - Fax:623-935-6601
Practice Address - Street 1:14940 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 420
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7311
Practice Address - Country:US
Practice Address - Phone:623-935-1999
Practice Address - Fax:623-935-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDC4819Medicare PIN